Korean J Leg Med.  2020 Nov;44(4):150-156. 10.7580/kjlm.2020.44.4.150.

A Study on the Usefulness of Postmortem Diabetes Mellitus-Related Tests

Affiliations
  • 1Division of Forensic Medicine, National Forensic Service Seoul Institute, Seoul, Korea
  • 2Division of Forensic Medicine, National Forensic Service Seoul Institute, Seoul, Korea
  • 3Medical Examiner’s Office, National Forensic Service, Wonju, Korea
  • 4Department of Forensic Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
  • 5Department of Laboratory Medicine, Kyungpook National University Chilgok Hospital, Daegu, Korea

Abstract

Diabetes mellitus (DM) is a group of metabolic disorders, that have become a major cause of death worldwide. This study aimed to determine the usefulness of diabetes-related laboratory tests for diagnosis of postmortem DM. From March to August 2018, among the autopsy cases investigated by the National Forensic Service, heart blood and vitreous humor samples from 253 cases that had not been decomposed were collected, and the data from 208 cases except 45 cases that were incapable of testing were analyzed for statistical significance and compared with the causes of death on autopsy reports. The levels of C-peptide, insulin, acetoacetate, β-hydroxybutyrate (β-HA), total ketone, and HbA1c were measured in the heart blood, and the levels of glucose, blood urea nitrogen, creatinine, and potassium were measured in the vitreous humor. The levels of glucose in the vitreous humor and HbA1c, β-HA, and total ketone in the heart blood were significantly correlated. C-peptide and insulin levels were lower than normal levels in most cases (C-peptide 92.3%, P=0.480, insulin 97.6%, P=0.589), and were not useful measures indicating diabetic complications. In the group with DM history, the average levels of HbA1c from the heart blood and glucose from the vitreous humor were higher than in those with no or unknown history of DM, indicating their usefulness as diagnostic tools. The results of this study suggest a postmortem DM diagnosis model. Therefore, postmortem DM-related tests can help diagnose the cause of death in forensic medicine.

Keyword

Diabetes mellitus; Postmortem examination; HbA1c; Insulin; C-peptide; Glucose
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